---
title: >-
  Cardiovascular risk assessment tools are insufficient for patients with
  metabolic dysfunction associated steatotic liver disease.
description: >-
  Explore this publication on real-world evidence: Cardiovascular risk
  assessment tools are insufficient for patients with metabolic dysfunction
  associated…
date: '2025-01-01'
category: Publications
tags:
  - American Journal of Gastroenterology
  - Abstract / Manuscript
  - R&D
  - Care
  - Hepatology
  - MASH/MASLD
  - Health System Partner
canonical_url: >-
  https://www.pedestalhealth.com/resources/publications/american-journal-gastroenterology/cardiovascular-risk-assessment-tools-are-insufficient-for/
source: Pedestal Health
license: © 2026 Pedestal Health. All rights reserved.
slug: cardiovascular-risk-assessment-tools-are-insufficient-for
id: lW253HHobU9L1YQfcYrmW
contentType: article
---

## Challenge

Standard cardiovascular risk prediction tools, the Framingham Risk Score, Pooled Cohort Equations, and AHA PREVENT, were derived from general populations and have never been validated specifically in MASLD, a condition where CV death is the leading cause of mortality. Their discriminatory performance and calibration in patients with progressive liver disease across the MASLD spectrum was unknown.

## Solution

The longitudinal TARGET-NASH cohort provided over 5 years of prospectively tracked CV events and liver disease staging across more than 1,000 patients, enabling head-to-head evaluation of multiple risk models against observed outcomes, a validation study architecture that requires the kind of persistent, multi-site real-world follow-up that Target RWE's infrastructure uniquely supports.

## Impact

Demonstrating that standard CV risk tools systematically miscalibrate in MASLD patients, both over- and underestimating risk depending on disease severity, provides direct evidence that MASLD should be treated as an independent CV risk modifier, supporting a clinical and regulatory case for MASLD-specific risk stratification in both treatment guidelines and cardiovascular endpoint design for MASLD trials.

### [Derek Gazis](/people/derek-gazis/)

![Derek Gazis, MS — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/1e4BaL8aZ7BBWMVV2cF6ev/425b52e4014543560f321fe4edd37631/derek-gazis.jpg)

### [Heather L. Morris](/people/heather-morris/)

![Heather Morris, PhD — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/16PnQ817q7tv964vhcUD5f/ce6797c32df11f022ef12ecbb9ffea49/heather-morris.jpg)

### [Andrea R. Mospan](/people/andrea-mospan/)

![Andrea R. Mospan, PhD, RAC — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/4w6bkwPHPqrXKYs4tHZPkK/1d21763b54ecc3466764986693b7072f/andrea-mospan.jpg)